Spondylolisthesis is derived from the greek words spondylo and listhesis. Spondylo is greek for vertebra, listhesis is greek for translation. Spondylolisthesis refers to translation of one vertebra over the vertebra directly below it.
Spondylolisthesis is most commonly a result of spondylolysis, a fracture of the pars interarticularis. The fractured pars interarticularis results in an instability of the vertebral motion segment, allowing the top vertebra to translate on the vertebra below it.
The translation or movement can occur in an anterior direction (anterolisthesis) or a posterior direction (retrolisthesis), and occurs most commonly in the anterior direction. The top vertebra translates or slides forward over the vertebra below it.
Spondylolisthesis is classified according to the percentage of the top vertebra that translates forward on the bottom vertebra.
Spondylolisthesis Classification
- Grade I < 25%
- Grade II 25-50%
- Grade III 50-75%
- Grade IV 75-100%
Spondylolisthesis is not an uncommon condition, though many people never know they have it because they are asymptomatic. Adolescent athletes are at higher risk of developing spondylolisthesis because of the forces placed through the spine with certain movements and activities.
Exercise, with a focus on core stabilization training is effective in treating symptomatic spondylolisthesis.
FAQ
Spondylolisthesis is a condition of the spine that involves one vertebra moving on the vertebra below it. It’s most commonly the result of a pars interarticularis defect. The pars interarticularis is an area between facet joints, on the back part of the vertebra. The vertebra above will usually move forward on the vertebra below. Spondylolisthesis is classified according to how much the vertebra above has moved forward on the vertebra below.
Grade I < 25%
Grade II 25-50%
Grade III 50-75%
Grade IV 75-100%
Lumbar extension usually makes spondylolisthesis worse. Lumbar extension makes spondylolisthesis worse because it places forces anterior (forward) shearing forces through the lower back. Because of the spondylolisthesis the lower back is not able to tolerate this direction of force adequately. Exercises that strengthen the anterior (front) core and gluts help check anterior shear forces through the lumbar spine. Lumbar stabilization training is especially important with spondylolisthesis in order to minimize excessive lumbar extension during sports, exercise, etc.
Spondylolisthesis is usually the result of a pars interarticularis defect.
Spondylolisthesis is left untreated the majority of the time, many people who have it don’t even know. For grade I and II spondylolisthesis, physical therapy with a focus on lumbar stabilization training is effective 85% of the time. In the presence of progressive neurological deficits, cauda equina syndrome, failed conservative therapy, or progressive subluxation to greater than grade II surgery may be indicated.
Management of spondylolisis and low-grade spondylolisthesis in fine athletes. A comprehensive review.
Nonoperative treatment of spondylolysis and grade I spondylolisthesis in children and young adults: a meta-analysis of observational studies.
The current management of lumbar spondylolisthesis.
